目的探讨脊柱微创通道镜系统辅助椎间孔腰椎椎体间融合术(TLIF)对腰椎退行性疾病患者脊髓功能及血清P物质(SP)、前列腺素E2(PGE2)水平的影响。方法选取51例腰椎退行性疾病患者,按照入院次序单双号法分为A组(n=25)及B组(n=26)。A组行脊...目的探讨脊柱微创通道镜系统辅助椎间孔腰椎椎体间融合术(TLIF)对腰椎退行性疾病患者脊髓功能及血清P物质(SP)、前列腺素E2(PGE2)水平的影响。方法选取51例腰椎退行性疾病患者,按照入院次序单双号法分为A组(n=25)及B组(n=26)。A组行脊柱微创通道镜系统辅助TLIF术治疗,B组行常规TLIF术治疗。比较两组手术指标,腰腿部疼痛与功能障碍状况,脊髓功能,血清P物质(SP)、前列腺素E2(PGE2)水平。结果A组术中失血量、术后引流量均少于B组,下床活动时间短于B组(P<0.05);术后4周两组腰腿部视觉模拟评分法(VAS)与Oswestry障碍指数(ODI)评分均较术前均明显改善(P<0.05);术后7 d两组各项脊髓功能指标较术前均明显改善,且A组改善幅度优于B组(P<0.05);术后3 d A组血清SP水平高于B组,而血清PGE2水平低于B组(P<0.05)。结论脊柱微创通道镜系统辅助TLIF术可显著改善腰椎退行性疾病患者脊髓功能以及疼痛介质水平。展开更多
目的:在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法:使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万...目的:在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法:使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据(WANFANG)、维普资讯(VIP)进行检索,选取2010年1月至2023年12月发表的,ULIF与MIS-TLIF治疗腰椎管狭窄症疗效比较的临床对照研究,由两名评价员独立提取资料,利用纽卡斯尔–渥太华量表(NOS)对纳入文献质量进行评价。观察治疗前后,ULIF组与MIS-TLIF组的主要疗效指标(手术时间、术中失血量、术后住院天数、手术节段椎间隙高度、血清肌酸激酶(CK)、血清C反应蛋白(CRP)、Bridewell椎间融合率、腰痛VAS评分、腿痛VAS评分、Oswestry功能障碍指数(ODI)、术后优良率、术后并发症)并对符合纳入标准的研究采用RevMan 5.4软件进行Meta分析。结果:共纳入1篇前瞻性研究和8篇回顾性研究,分为ULIF组(327例)和MIS-TLIF组(338例)。Meta分析结果显示:与ULIF组相比,MIS-TLIF组手术时间更短,术后第1天MIS-TLIF组CK较ULIF组高。ULIF组住院时间更短,术前椎间隙高度ULIF组较低,ULIF组术后第3个月腰痛VAS评分较低,ULIF组术后第1个月ODI较低。其余各时间点两组术中失血量、腰腿痛VAS评分、ODI、CK、CRP、椎间隙高度、椎间融合率、术后优良率、术后并发症比较均无统计学意义。结论:MIS-TLIF较ULIF手术时间更短,但ULIF较MIS-TLIF术中对组织破坏更少,术后住院时间更短,短期内腰腿功能恢复更具优势。Objective: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis (LSS). Methods: A computer-based search was conducted on domestic and international databases including PubMed, Medline, Chinese Biomedical Literature Database (CBM), CNKI, WANFANG, and VIP. Clinical controlled studies published between January 2010 and December 2023 comparing the efficacy of ULIF and MIS-TLIF for LSS were selected. Two evaluators independently extracted data and assessed the quality of included literature using the Newcastle-Ottawa Scale (NOS). The primary efficacy indicators (surgical time, intraoperative blood loss, postoperative hospital stay, intervertebral disc height, serum creatine kinase (CK), serum C-reactive protein (CRP), Bridewell interbody fusion rate, VAS scores for back pain and leg pain, Oswestry Disability Index (ODI), postoperative success rate, and postoperative complications) were observed before and after treatment in both groups. A Meta-analysis was performed using RevMan 5.4 software for studies that met the inclusion criteria. Results: A total of 1 prospective study and 8 retrospective studies were included, comprising 327 cases in the ULIF group and 338 cases in the MIS-TLIF group. Meta-analysis results indicated that compared to the ULIF group, the MIS-TLIF group had shorter surgical times and higher CK levels on the first postoperative day. The ULIF group had shorter hospital stays, lower preoperative disc heights, lower VAS scores for back pain at 3 months postoperatively, and lower ODI scores at 1 month postoperatively. No statistically significant differences were found between the two groups for intraoperative blood loss, VAS scores for back and leg pain, ODI, CK, CRP, intervertebral disc height, fusion rates, postoperative success rates, or postoperative complications. Conclusion: MIS-TLIF has a shorter surgical time compared to ULIF, but ULIF results in less tissue damage, shorter hospital stays, and greater advantages in short-term recovery of lumbar and leg function.展开更多
文摘目的探讨脊柱微创通道镜系统辅助椎间孔腰椎椎体间融合术(TLIF)对腰椎退行性疾病患者脊髓功能及血清P物质(SP)、前列腺素E2(PGE2)水平的影响。方法选取51例腰椎退行性疾病患者,按照入院次序单双号法分为A组(n=25)及B组(n=26)。A组行脊柱微创通道镜系统辅助TLIF术治疗,B组行常规TLIF术治疗。比较两组手术指标,腰腿部疼痛与功能障碍状况,脊髓功能,血清P物质(SP)、前列腺素E2(PGE2)水平。结果A组术中失血量、术后引流量均少于B组,下床活动时间短于B组(P<0.05);术后4周两组腰腿部视觉模拟评分法(VAS)与Oswestry障碍指数(ODI)评分均较术前均明显改善(P<0.05);术后7 d两组各项脊髓功能指标较术前均明显改善,且A组改善幅度优于B组(P<0.05);术后3 d A组血清SP水平高于B组,而血清PGE2水平低于B组(P<0.05)。结论脊柱微创通道镜系统辅助TLIF术可显著改善腰椎退行性疾病患者脊髓功能以及疼痛介质水平。
文摘目的:在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法:使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据(WANFANG)、维普资讯(VIP)进行检索,选取2010年1月至2023年12月发表的,ULIF与MIS-TLIF治疗腰椎管狭窄症疗效比较的临床对照研究,由两名评价员独立提取资料,利用纽卡斯尔–渥太华量表(NOS)对纳入文献质量进行评价。观察治疗前后,ULIF组与MIS-TLIF组的主要疗效指标(手术时间、术中失血量、术后住院天数、手术节段椎间隙高度、血清肌酸激酶(CK)、血清C反应蛋白(CRP)、Bridewell椎间融合率、腰痛VAS评分、腿痛VAS评分、Oswestry功能障碍指数(ODI)、术后优良率、术后并发症)并对符合纳入标准的研究采用RevMan 5.4软件进行Meta分析。结果:共纳入1篇前瞻性研究和8篇回顾性研究,分为ULIF组(327例)和MIS-TLIF组(338例)。Meta分析结果显示:与ULIF组相比,MIS-TLIF组手术时间更短,术后第1天MIS-TLIF组CK较ULIF组高。ULIF组住院时间更短,术前椎间隙高度ULIF组较低,ULIF组术后第3个月腰痛VAS评分较低,ULIF组术后第1个月ODI较低。其余各时间点两组术中失血量、腰腿痛VAS评分、ODI、CK、CRP、椎间隙高度、椎间融合率、术后优良率、术后并发症比较均无统计学意义。结论:MIS-TLIF较ULIF手术时间更短,但ULIF较MIS-TLIF术中对组织破坏更少,术后住院时间更短,短期内腰腿功能恢复更具优势。Objective: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis (LSS). Methods: A computer-based search was conducted on domestic and international databases including PubMed, Medline, Chinese Biomedical Literature Database (CBM), CNKI, WANFANG, and VIP. Clinical controlled studies published between January 2010 and December 2023 comparing the efficacy of ULIF and MIS-TLIF for LSS were selected. Two evaluators independently extracted data and assessed the quality of included literature using the Newcastle-Ottawa Scale (NOS). The primary efficacy indicators (surgical time, intraoperative blood loss, postoperative hospital stay, intervertebral disc height, serum creatine kinase (CK), serum C-reactive protein (CRP), Bridewell interbody fusion rate, VAS scores for back pain and leg pain, Oswestry Disability Index (ODI), postoperative success rate, and postoperative complications) were observed before and after treatment in both groups. A Meta-analysis was performed using RevMan 5.4 software for studies that met the inclusion criteria. Results: A total of 1 prospective study and 8 retrospective studies were included, comprising 327 cases in the ULIF group and 338 cases in the MIS-TLIF group. Meta-analysis results indicated that compared to the ULIF group, the MIS-TLIF group had shorter surgical times and higher CK levels on the first postoperative day. The ULIF group had shorter hospital stays, lower preoperative disc heights, lower VAS scores for back pain at 3 months postoperatively, and lower ODI scores at 1 month postoperatively. No statistically significant differences were found between the two groups for intraoperative blood loss, VAS scores for back and leg pain, ODI, CK, CRP, intervertebral disc height, fusion rates, postoperative success rates, or postoperative complications. Conclusion: MIS-TLIF has a shorter surgical time compared to ULIF, but ULIF results in less tissue damage, shorter hospital stays, and greater advantages in short-term recovery of lumbar and leg function.
文摘目的:比较后入路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)和经皮内镜下经椎间孔腰椎椎体间融合术(percutaneous endoscopic transforaminal lumbar interbody fusion,PE-TLIF)治疗单节段腰椎管狭窄症的临床疗效及其对椎旁肌的影响。方法:本前瞻性研究纳入本院2019年1月~2022年1月收治的52例L4/5单节段腰椎管狭窄症患者。其中,PLIF组22例,女性10例,男性12例,年龄60.2±10.3岁;PE-TLIF组30例,女性14例,男性16例,年龄60.4±12.3岁。对比两组手术时间、术中出血量、术后引流量、术后卧床时间等围手术期指标;比较术前与术后1d及1周血清肌酸激酶(creatine kinase,CK),术前与术后6个月及12个月多裂肌(multifidus,MF)横截面积(cross-sectional area,CSA)、脂肪浸润(fatty infiltration,FI)评分及肌肉CT密度等椎旁肌评估指标;比较两组患者术前、术后1d、1周、6个月及12个月腰痛视觉模拟评分(visual analogue scale on low back pain,VAS-LBP)、腿痛视觉模拟评分(visual analogue scale on leg pain,VAS-LP)、Oswestry功能障碍指数(Oswestry disability index,ODI)。对两组术后并发症发生情况进行比较,术后12个月根据Bridwell标准评估两组椎间融合情况。结果:PE-TLIF组与PLIF组手术时间(211.2±38.5min vs 98.9±31.6min,P=0.000)、术后卧床时间(25.9±8.3h vs 52.4±14.8h,P=0.001)、术中失血量(112.8±79.6mL vs 232.5±122.5mL,P=0.002)、术后引流量(46.5±28.2mL vs 283.6±142.1mL,P=0.000)相比,差异均具有统计学意义。PE-TLIF组与PLIF组术前、术后6个月及12个月目标节段MF CSA组间比较均无明显差异(P>0.05),两组术前与术后6个月及12个月的目标节段MF CSA组内比较无明显差异(P>0.05)。PE-TLIF组与PLIF组术前、术后6个月目标节段MF FI评分组间比较无统计学差异(P>0.05),术后12个月,PLIF组目标节段MF FI评分较PE-TLIF组高,差异具有统计学意义[3.0(3.0,4.0)vs 3.0(2.8,3.0),P=0.031];PE-TLIF组术前与术后6个月、12个月目标节段MF FI评分组内比较无明显差异(P>0.05),PLIF组术前与术后6个月目标节段MF FI评分组内比较未发现明显差异(P=0.257),而术前与术后12个月比较,差异具有统计学意义[3.0(2.0,3.3)vs 3.0(3.0,4.0),P=0.016]。术前、术后6个月两组患者MF CT密度相比较无明显差异(P>0.05)。术后12个月,PLIF组目标节段MF密度明显降低,差异具有统计学意义[PE-TLIF:34.2(31.8,36.9)HU;PLIF:30.5(28.5,32.1)HU,P=0.000]。组内比较,PE-TLIF组术前与术后6个月、12个月目标节段MF肌肉密度比较差异无显著统计学意义(P>0.05)。PLIF组术前与术后6个月目标节段MF CT密度比较,未发现明显差异(P=0.516),术后12个月较术前明显升高,差异具有统计学意义[34.6(30.5,36.4)HU vs 30.5(28.5,32.5)HU,P=0.017]。PE-TLIF组与PLIF组术前CK值无明显差异(P=0.712)。术后1d、7d,PE-TLIF组CK值低于PLIF组(P<0.05)。PE-TLIF组与PLIF组患者术后随访VAS-LP、VAS-LBP评分以及ODI均优于术前,差异具有统计学意义(P<0.05)。术后1d、7d,PE-TLIF组VAS-LBP评分表现优于PLIF组(P<0.05)。术后6个月、12个月,两组患者的VAS-LBP评分比较无明显差异(P>0.05)。两组患者的VAS-LP评分以及ODI在随访时无明显差异(P>0.05)。两组患者术后并发症发生率比较无统计学差异(P=0.379),术后12个月两组患者椎间融合情况比较无统计学差异(P=0.877)。结论:PE-TLIF治疗单节段腰椎管狭窄症可获得与传统PLIF手术相同的临床疗效,且减小了对椎旁肌的影响,可减轻手术创伤。
